THE Hanwell District School receives the children of the poorest class from Southwark and the City of London ; the Ophthalmic receives those children who are suffering with eye troubles, especially ophthalmia, from all the Metropolitan Poor-Law Schools. For permission to make the examination I am indebted to the Governors. I must also express my best thanks for great help to Dr. Littlejohn, who is in medical charge of the combined schools, and also to Mr. Sydney Stephenson, who has care of the

more »

... phthalmic department. The object for which the examination was undertaken was to ascertain what proportion of children suffer from diseases of the ear, in order that attention might, if necessary, be drawn to the subject; and that, as so many of the dangers to life and hearing have their origin in childhood, means might be taken to guard against them during that period of life. In conducting the examination, each child was placed 18 feet away, and simple questions in a quiet whisper were asked : (1) With both ears unclosed and the eyes shut; and (2) with one unclosed ear first turned to me, and then the other. After the result was noted, the ears, nose, pharynx, and in a large number the naso-pharynx, were examined. If necessary, tuning-fork tests were applied, but in all the middle-ear cases politzerisation Mas employed, in order that the diagnosis might be strengthened by the improvement obtained. A distance of 18 feet was used, as it was found to be a convenient one in the first room in which the examination took place, and was therefore employed all through. The test erred on the side of leniency, but formed a good working standard. The whispered voice test is often deceptive to the examiner, but in nervous, stupid, or very young children it is the only one possible; a positive result can usually be obtained, and is less deceptive than a child's answer to the watch. Examination of the naso-pharynx for adenoids was made in all children in whom the ears were affected, and those in whom from any appearance or sj'mptom they might be suspected.